What should I do if my patient has a contrast reaction?!

These are several guidelines for treatment of patients with reactions to intravenous contrast material - dependent on the symptoms:

Urticaria

• Asymptomatic: No treatment is needed.
• Symptomatic, mild or moderate: Diphenhydramine 50 mg may be administered orally, intramuscularly, or intravenously.
• Severe: Treatment is as above; consider adding cimetidine 300 mg by slow intravenous injection or ranitidine 50 mg by slow intravenous injection.

Bronchospasm

• Mild: Treatment includes oxygen 10-12 L by face mask, close observation, and/or 2 puffs of an albuterol or metaproterenol inhaler.
• Moderate, without hypotension: Treatment is as above, with epinephrine 1:1000, 0.1-0.3 mL given subcutaneously, repeated every 10-15 minutes as needed until 1 mL is administered.
• Severe: Administer epinephrine 1:10,000 1 mL slow intravenous injection over approximately 5 minutes, repeated every 5-10 minutes as needed.

Laryngeal edema

• Mild to moderate: Treatment includes oxygen 10-12 L by face mask and epinephrine 1:1000 0.1-0.3 mL given subcutaneously, repeated every 10-15 minutes as needed until 1 mL is administered.
• Moderate to severe: Consider calling a code or intubating the patient. Consider adding diphenhydramine 50 mg slow intravenous injection and cimetidine 300 mg slow intravenous injection or ranitidine 50 mg slow intravenous injection.

Isolated hypotension

• Raise the patient's legs as much as possible while preparing to administer intravenous fluids.
• The Trendelenburg position can also be effective, but many radiographic tables do not tilt.
• Oxygen should be administered in high doses.

Hypotension with tachycardia

• Mild to moderate: Elevate the patient's legs. Administer oxygen 10-12 L by face mask, and intravenous isotonic fluid (eg, 0.9% isotonic sodium chloride solution, Ringer lactate solution).
• Severe or unresponsive: Treatment is as above, with dopamine 2-20 mcg/kg/min. Call a code if no response occurs.

Vasovagal reaction

• Mild to moderate reaction: Elevate the patient's legs. Administer oxygen 10-12 L by face mask, and intravenous isotonic fluid (eg, 0.9% isotonic sodium chloride solution, Ringer lactate solution).
• Severe reaction or unresponsive patient: Administer intravenous atropine 0.6-1 mg, repeated every 3-5 minutes as needed until a total of 3 mg is administered.

Unresponsive patient

• Call a code.
• Defibrillation may be needed to treat ventricular fibrillation and pulseless ventricular tachycardia.
• Administer basic life support.

More information about contrast medium reactions can be reviewed here.

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